Evaluation of fluid responsiveness in patients with septic shock by critical ultrasound with small dose fluid challenge / 中华危重病急救医学

Objective:To explore the value of critical ultrasound in evaluating the fluid responsiveness of small dose volume challenge in patients with septic shock.Methods:Thirty-six patients with septic shock admitted to the Third People's Hospital of Datong from January 2021 to December 2021 were enrolled, and the patients were randomly divided into control group and observation group, with 18 patients in each group. The control group was treated with traditional fluid challenge (500 mL of crystalloid injected within 30 minutes); the observation group received a small dose fluid challenge (100 mL of crystalloid injected within 1 minute). The hemodynamic indexes [central venous pressure (CVP), invasive mean arterial pressure (MAP), velocity-time integra (VTI)] and bilateral lung ultrasound scores were measured by critical ultrasound in both groups. The outcome related indicators of patients in the two groups were observed. The correlation between the above indexes and the fluid challenge was evaluated.Results:Compared with the control group, the heart rate (HR) and CVP of patients in the observation group after the challenge were significantly lower than those in the control group [HR (times/min): 99.74±3.22 vs. 107.65±3.14, CVP (mmHg, 1 mmHg ≈ 0.133 kPa): 7.55±0.22 vs. 10.26±0.52, both P < 0.05], invasive MAP and VTI were significantly higher than those in the control group [invasive MAP (mmHg): 77.36±2.14 vs. 69.81±2.56, VTI (cm/s): 68.85±1.26 vs. 44.71±1.28, both P < 0.05]. The ultrasonic score of the observation group was significantly better than those of the control group (all P < 0.05). In terms of outcome, the length of intensive care unit (ICU) stay, mechanical ventilation time and the time for urine volume more than 0.5 mL·kg -1·h -1 of the observation group were significantly shorter than those in the control group [the length of ICU stay (hours): 138.26±1.25 vs. 205.73±1.26, mechanical ventilation time (hours): 36.80±0.25 vs. 47.65±0.36, time to reach urine volume more than 0.5 mL·kg -1·h -1 (hours): 27.38±1.25 vs. 38.61±1.30, all P < 0.05], The dosage of norepinephrine was significantly decreased in the observation group compared with the control group (mg: 45.26±1.85 vs. 53.73±1.92, P < 0.05), and the amount of resuscitation crystalloid was significantly reduced compared with the control group (mL: 1 532.62±12.38 vs. 1 755.52 ± 12.30, P < 0.05). Correlation analysis showed that the volume of crystalloid was highly consistent with M-BLUE pulmonary ultrasound (zone 2, 4 and 5), mechanical ventilation time, norepinephrine dose, time to reach the standard of urine volume and ΔVTI (all P < 0.05). Conclusions:Small dose fluid challenge evaluated by critical ultrasound in septic shock patients has a high value for fluid responsiveness, which can better reduce the risk of obvious tissue edema caused by fluid overload, organ damage and even life-threatening, make fluid challenge more reasonable and appropriate, thereby improving the success of treatment.

Effects of Small Dose of Bupivacaine Lumbar-Epidural Block on Related Indexes in Women Underwent Ce-sarean Section / 中国药房

OBJECTIVE:To investigate the effects of small dose of bupivacaine lumbar-epidural block on related indexes inwomen underwent cesarean section. METHODS:124 singleton term primipara underwent elective cesarean section were randomly divided into observation group(62 cases)and control group(62 cases). Observation group received 0.5% bupivacaine 7.5 mg lum-bar anesthesia+1.6% lidocaine epidural block. Control group received 0.5% bupivacaine 10 mg lumbar anesthesia+1.6% lidocaine epidural block. HR,SBP,DBP,onset time of sensory block,fixation time of block level,operation start time,the occurrence of traction reaction and supine hypotensive syndrome,the application of ephedrine,Apgar score the occurrence of ADR were ob-served in 2 groups before anesthesia(T0),1(T1),3(T2),5 min(T3)after anesthesia,at skin incision(T4),after fetal disengage-ment(T5). RESULTS:There was no statistical significance in HR,SBP and DBP between 2 groups at T0(P>0.05). There was no statistical significance in HR,SBP and DBP of observation group at different time points(P>0.05). At T1-3,SBP and DBP of con-trol group were significantly lower than at T0 and observation group;HR was significantly higher than at T0 and observation group, with statistical significance(P0.05);there was no statistical significance in above 3 indexes of control group at T4-5,compared to at To and observation group(P>0.05). The onset time of sensory block,fixation time of block level and operation start time in observation group were all longer than control group;the incidence of supine hypotensive syndrome,the number of ephedrine cases,the amount of ephed-rine,the incidence of nausea and vomiting,the incidence of postoperative urinary retention were significantly lower than control group;the incidence of traction reaction was significantly higher than control group,with statistical significance(P0.05). CONCLUSIONS:The small dose of bupivacaine lumbar-epidural block for women underwent cesarean section keep he-modynamics stable and reduce the incidence of supine hypotensive syndrome without increasing the incidence of ADR.

Clinical Observation of Small Dose of Octreotide for Preventing Hyperamylasemia and Acute Pancreatitis after Endoscopic Retrograde Cholangiopancreatography / 中国药房

OBJECTIVE:To observe clinical effects and safety of small dose of octreotide for preventing hyperamylasemia and acute pancreatitis after endoscopic retrograde cholangiopancreatography (ERCP).METHODS:One hundred and twenty ERCP pa tients were selected from our hospital during Oct.2014-Jan.2015 and then divided in to observation group and control group in accordance with random number table,with 60 cases in each group.Both groups were given Diazepam tablet 10 mg+Meperidine hydrochloride tablet 100 mg+Phenobarbital scopolamine tablet 2 tablets 0.5 h before surgery for sedation and analgesia,and routine acid suppression and anti-infective therapy.Observation group was additionally given Octreotide acetate injection 0.1 mg hypodermically and then given Octreotide acetate injection 0.1 mg immediately after surgery,8 h after surgery.The levels of serum amylase and blood glucose were observed in 2 groups,and the occurrence of postoperative complication and ADR were recorded.RESULTS:Before operation,there was no statistical significance in the levels of serum amylase and blood glucose between 2 groups (P＞ 0.05).After operation,the level of serum amylase in control group was significantly higher than in observation group,with statistical significance (P＜0.05).There was no statistical significance in blood glucose level between 2 groups after operation (P＞0.05).The incidence of hyperamylasemia and ADR in observation group was significantly lower than in control group,with statistical significance (P＜0.05),and there was no statistical significance in the incidence of acute pancreatitis between 2 groups after operation (P＞0.05).CONCLUSIONS:Small dose of octreotide can effectively reduce the level of serum amylase and the incidence of hyperamylasemia after ERCP with good safety.

Study on effect of low dose of dexmedetomidine on nausea and vomiting in patients with cervical cancer minimally invasive surgery / 重庆医学

Objective To explore the effect of small dose of dexmedetomidine on nausea and vomiting in the patients with cervical cancer minimally invasive surgery .Methods One hundred and twenty-two cases of cervical cancer minimally invasive sur-gery in the hospital from June 2014 to June 2016 were selected as the research subjects and divided into the control group and obser-vation group according to the random number table method ,61 cases in each group .The observation was intravenously injected by 0 .1μg/k dexmedetomidine for 1 min before anesthesia induction ,while the control group was given the same volume of normal sa-line .The perioperative indexes ,nausea and vomiting grade and adverse reactions occurrwence were comparfed between the two groups .The anesthesia time ,operative time ,eye opening time ,autonomous respiratory recovery time and tracheal tube extubation time had no statistical differences between the two groups were compared .Results The intraoperative HR minimum value in the observation group was lower than that in the control group ,the bradycardia occurrence rate was higher than that in the control group ,the difference was statistically significant (P<0 .05) .The constituent ratio of PONV grade Ⅱat T2 time point in the obser-vation group was significantly lower than that in the control group ,and the occurrence rate of nausea and vomiting at T 4(postopera-tive 24 h) in the observation group was significantly lower than that in the control group ,the difference was statistically significant (P<0 .05) .The occurrence rate of agitation in the control group was higher than that in the observation group ,and the difference was statistically significant (P<0 .05) .Conclusion Small dose of dexmedetomidine can significantly alleviate postoperative nausea and vomiting in the patients with cervical cancer minimally invasive surgery ,moreover can decrease the agitation occurrence rate without affecting the effect of anesthesia ,but is prone to develop bradycardia .

Nursing intervention of small dose paclitaxel synchronous chemotherapy and radiotherapy in non-small cell lung cancer (middle and advanced stage) / 中国生化药物杂志

Objective To observe the effect of low-dose paclitaxel concurrent chemotherapy of advanced non-small cell lung cancer in the application in the treatment, analysis of the nursing intervention. Methods From February 2014 to March 2017 in our hospital 31 cases of advanced non-small cell lung cancer patients as the research object, the patients were given low-dose paclitaxel concurrent radiotherapy chemotherapy in the treatment of patients with adverse reactions, according to the selection of targeted nursing intervention, observation of this group of patients. Results The degree of toxicity is the after treatment of the patients with psychological, clinical, prevention of infection, diet and other aspects of nursing intervention, all patients with adverse reactions were mitigated, and completed the treatment program. Conclusion Low dose paclitaxel concurrent radiotherapy and chemotherapy and the application of nursing intervention in advanced non-small cell lung cancer with precise, can effectively alleviate the adverse reaction in the treatment of patients, as a disease. It provides the guarantee for the prognosis of the disease and has practical value.

Nursing intervention of small dose paclitaxel synchronous chemotherapy and radiotherapy in non-small cell lung cancer (middle and advanced stage) / 中国生化药物杂志

Objective To observe the effect of low-dose paclitaxel concurrent chemotherapy of advanced non-small cell lung cancer in the application in the treatment, analysis of the nursing intervention. Methods From February 2014 to March 2017 in our hospital 31 cases of advanced non-small cell lung cancer patients as the research object, the patients were given low-dose paclitaxel concurrent radiotherapy chemotherapy in the treatment of patients with adverse reactions, according to the selection of targeted nursing intervention, observation of this group of patients. Results The degree of toxicity is the after treatment of the patients with psychological, clinical, prevention of infection, diet and other aspects of nursing intervention, all patients with adverse reactions were mitigated, and completed the treatment program. Conclusion Low dose paclitaxel concurrent radiotherapy and chemotherapy and the application of nursing intervention in advanced non-small cell lung cancer with precise, can effectively alleviate the adverse reaction in the treatment of patients, as a disease. It provides the guarantee for the prognosis of the disease and has practical value.

Clinical effect of small dose of glucocorticoid in the treatment of AECOPD patients with severe disease associated with low levels of cortisol / 中国生化药物杂志

Objective To explore clinical effect of small dose of glucocorticoid in the treatment of AECOPD patients with severe disease associated with low levels of cortisol.Methods72 patients with AECOPD in our hospital were randomly divided into control group and treatment group.The control group was treated with conventional AECOPD method,the treatment group was treated on the base of the treatment group with a small dose of corticosteroids,CRP, IL-6, TNF-α, FEV1, PCT and other indicators, as well as patients with ventilation, shock and mortality were compared after the end of treatment.ResultsThe time of non mechanical ventilation, the time of non-mechanical ventilation, and the time of non-shock were increased, the shock and the mortality was lower in the treatment group,(P<0.05);The CRP level of patients in the treatment group was lower(P<0.05);IL-6, TNF-α, PCT levels of patients in the treatment group was lower (P<0.05);FEV1, FVC and FEV1/FVC level in the treatment group were higher(P<0.05).ConclusionSmall dose glucocorticoid can improve the pulmonary function of patients with AECOPD complicated by severe disease, and alleviate the disease, significantly reduce the levels of inflammatory factors, promote the improvement of the lung function.

Clinical observation of low dose sufentanil in preventing shivering and pulling pain during cesarean section anesthesia / 中国生化药物杂志

Objective To investigate and analyze the clinical observation of low dose sufentanil in the prevention of shivering and traction during cesarean section. Methods 100 cases of cesarean section in our hospital from January 2015 to December 2016 were selected and randomly divided into two groups, the control group and the experimental group, with 50 patients in each group. The control group received bupivacaine anesthesia, and the experimental group received sufentanil anesthesia on the basis of sufentanil. The clinical indexes of the experimental group and the control group were compared and analyzed. Results After the corresponding anesthesia, there was no moderate or severe traction pain in the experimental group and the control group, and 29 cases of mild traction pain in the control group, with a rate of 58%. There were 7 patients with mild traction pain in the experimental group, with a rate of 14%. The probability of mild traction pain in the experimental group was significantly lower than that in the control group, with statistical difference (P<0.05). The incidence of shivering in the experimental group was 16%, significantly lower than that in the control group, with a rate of 52%, which was statistically significant (P<0.05). The adverse reaction rate of the experimental group was 12%, significantly lower than that of the control group, the probability of occurrence was 42%, which was statistically significant (P<0.05). Conclusion The application of small dose of sufentanil in anesthesia in cesarean section can reduce the occurrence probability of visceral pain in a large extent, prevention of shivering, high safety, low incidence rate of adverse reaction, with further clinical promotion and application significance.

Effect of low dose of dexamethasone combined with mannitol on early swelling of oral and maxillofacial injuries / 中国生化药物杂志

Objective To explore the effect of low dose of dexamethasone and mannitol on the early swelling of oral and maxillofacial injuries.Methods A total of 100 patients with oral and maxillofacial injuries who were treated in Huanggang City Center Hospital from February 2015 to January 2016 were divided into two groups by means of an envelope randomized group.Group 50 patients, group A patients received low doses of dexamethasone treatment, B group of patients on the basis of increased mannitol for treatment, compared the efficacy of both groups of patients with maxillofacial swelling improved.Results The clinical general improvement probability of group B was significantly higher than that of group A, and the distance between the horizontal direction and the vertical direction of group B was significantly higher than that of group A (P<0.05).Conclusion The combination of low dose dexamethasone and mannitol has a great effect on the early swelling of oral and maxillofacial injury, and it is worthy to be further implemented in the future clinical practice.

Clinical observation of low dose thyroxine combined with irbesartan and hydrochlorothiazide in the treatment of elderly patients with severe heart failure / 中国生化药物杂志

Objective To study the clinical efficacy of irbesartan hydrochlorothiazide combined with small dose thyroxine in the treatment of severe heart failure in the elderly. Methods 100 elderly patients with severe heart failure were selected as the research object (from January 2013 to December 2016). They were randomly divided into the control group and the experimental group, with 50 patients in each group. Patients in the control group received routine treatment, including diuretic therapy, cardiac treatment, and anti heart failure treatment. The experimental group was treated with low-dose thyroxine combined with irbesartan and hydrochlorothiazide on this basis. The clinical effects of the two groups were compared and analyzed. Results After the corresponding treatment, the number of invalid cases in the experimental group was 6 cases, 16 cases were effective, 28 cases were effective,and the total effective number was 44 cases. In the control group, the number of invalid cases was 15. The effective rate of the treatment group was 88.0％, which was significantly higher than that of the control group 70％, which was statistically significant (P<0.05). After treatment, the left ventricular ejection fraction, the level of four and three, and the level of serum thyroid stimulating hormone in the experimental group were significantly higher than those before treatment, with statistical difference (P<0.05). Conclusion Small dose thyroxine combined with irbesartan and hydrochlorothiazide is effective in the treatment of severe heart failure in elderly patients, and can significantly improve the heart function of patients, and has the significance of further clinical promotion.

Effect of Flurbiprofen Compound Small Dose Fentanyl on Intravenous Analgesia and Blood Coagulation Function of Patients with Laparoscopic Cholecystectomy / 现代生物医学进展

Objective:To research the application of flurbiprofen compound small dose fentanyl with self-control vein analgesia after laparoscopic cholecystectomy and the influence on blood coagulation function.Methods:102 cases with laparoscopic cholecystectomy who were treated in our hospital from November 2015 to November 2016 were selected and divided into the control group and the research group,with 51 cases in each group.The patients in the control group were treated with postoperative intravenous analgesia with low-dose fentanyl,while the patients in the research group were treated with postoperative intravenous analgesia with flurbiprofen ester compound low-dose fentanyl.Then the fibrinogen (Fg),activated partial prothrombin time (APTT),prothrombin time (PT),platelet count (PLT),substance P,5-hydrocarbon serotonin (5-HT),interleukin 6,8 (IL-6,IL-8) and complications between two groups were observed and compared.Results:Before treatment,there was no statistically significant difference about the Fg,APTT,PT,PLT,substance P,5-HT,IL-6 and IL-8 between two groups (P＞0.05);After treatment,the Fg,APTT,PT,PLT,substance P,5-HT,IL-6 and IL-8 increased in the two groups,while the research group was lower than that of the control group,and the differences were statistically significant (P＜0.05).The postoperative complication rate of research group was lower than that of the control group (P＜0.05).Conclusion:Flurbiprofen ester compound small dose fentanyl with self-control vein analgesia can relieve coagulation function,and inhibit the levels of inflammatory factors.

Effect of appling small molecule heparin calcium on long-term renal damage of patients with allergic purpura by Meta analysis / 中国生化药物杂志

Objective To evaluate small molecule heparin allergic purpura complicated by long-term kidney damage intervention by Meta analysis.Methods Databases of CNKI,Wanfang,VIP,CBM and Cochrane Library were searched,hand searching as an auxiliary, included studies were assessed by quality of analysis, Meta-analysis was conducted by Stata12.1 software line.Results 4 articles were included in randomized controlled clinical trials (randomized controlled trials, RCT), a sample of 670 cases, 333 cases of small molecule heparin calcium treatment group (37 cases of renal damage has occurred), 337 cases of control group (44 cases of renal damage has occurred), no difference between the 2 groups (RR=0.89, 95% CI:0.59-1.34, P=0.578).Conclusion The early application of small molecular weight heparin calcium can not prevent kidney damage, it needs to do in-depth research by multi-center, large-scale RCT.

Application of improved enema in low-dose retention enema for the treatment of ulcerative colitis / 现代临床护理

Objective To investigate the efficacy of low-dose retention enema for treating ulcerative colitis.Methods Eighty patients diagnosed with chronic recurrent ulcerative colitis were randomly divided into control group and observation group with equal number.The retention enema was used in the control group and the improved retention enema was used in the observation group. Enema was done once every night,10 days as a course of treatment in both groups.The two groups were compared in terms of liquid retention time,curative effect after two courses and patients’satisfaction degree with enema.Results The liquid retention time in the intestinal lumen in the observation group was significantly longer than that of the control group.The efficacy was significantly better than the control group.Patients satisfaction with enema in the observation group was significantly higher than that of the control group (P<0.05).Conclusions The improved low-dose liquid enema is effective in the treatment of ulcerative colitis for its liquid retention time in the intestines.It is effective,comfortable,convenient,and likely to be accepted by patients.

Effects of Small Dose of Epidural Ketamine on Analgesia for Patients after Surgical Intervention for Knee Stiffness / 中国康复理论与实践

@#Objective To observe the dose-effect relationship and side effects caused by epidural ketamine for patients after surgical intervention for knee stiffness (SIKS). Methods 80 patients undergoing SIKS at one knee joint under combined spinal and epidural anesthesia were randomly divided into 4 groups. Patients in these groups would receive analgesia respectively provided by femoral nerve block (FNB)(group C, n=20), FNB combined with 0.15 mg/kg epidural ketamine (group K1, n=20), FNB combined with 0.2 mg/kg epidural ketamine(group K2, n=20), and FNB combined with 0.25 mg/kg epidural ketamine (group K3, n=20). When spinal anesthesia was finished, the corresponding dose of ketamine was injected in patients in groups K1, K2, and K3 and 0.9% sodium chloride was injected in group C via an epidural catheter. After the operation, a catheter was left in the femoral nerve sheath and the solution of 60 mg ropivacaine in 30 ml (0.2%) was injected. All patients were performed rehabilitation therapy at postoperative 8, 24, 32, and 48 h and the same ropivacaine solution was injected in the femoral nerve sheath before each rehabilitation therapy started. Visual analogue score (VAS), active range of motion (AROM) of the suffered knee joint, and side effects were observed. Results There were 73 patients enrolled in the final statistic analysis. At postoperative 8 h, the VAS scores were lower in groups K1, K2 and K3 than in group C (P<0.05). At postoperative 24 h, 32 h, and 48 h, the VAS scores were lower in groups K2 and K3 than in groups C and K1 (P<0.05). AROM was larger in groups K2 and K3 than in groups C and K1. patients appeared psychiatric symptoms in group K3. Conclusion Small dose of epidural ketamine is a feasible method for analgesia in early rehabilitation therapy and the dose of 0.2 mg/kg is effective and safe.

Application of Small Dose of Ketamine in Painless Gastroscopy / 中国康复理论与实践

@#Objective To observe the effect of intravenous small dose of ketamine combined with continuous infusion of propofol and sufentanyl in painless gastroscopy.Methods 62 patients undergoing painless gastroscopy under intravenous anesthesia were randomly divided into the control group and ketamine group with 31 cases in each group. The cases of the control group were treated with continuous infusion of propofol (target controlled infusion rate: 3.0 μg/ml) and sufentanyl (loading dose: 0.15 μg/kg, basal rate 0.15 μg/kg/h); those of the ketamine group were treated with intravenous small dose of ketamine 0.5 mg/kg combined with continuous infusion of propofol (target controlled infusion rate: 3.0 μg/ml) and sufentanyl (loading dose: 0.1 μg/kg, basal rate 0.1 μg/kg/h). The procedure of gastroscopy was started when patients were in unconsciousness and their vital signs were stable, and the infusion of medicine was stopped when the gastroscopy was finished. The systolic blood pressure (SBP) and heart rate (HR) at the time of before anesthesia, 1 minute after anesthesia, inserting the gastroscope, 10 minutes after inserting the gastroscope, and recovering from the anesthesia were recorded. The cases needing special respiratory management (SRM), displaying body movement (BM) in gastroscopy and post-operative nausea and vomiting (PONV) were recorded. The recovery time (RT) after gastroscopy was also recorded.Results No significant difference was found in SBP, HR, BM, PONV and RT between two groups ( P>0.05). Eight cases in the control group and one case in the ketamine group needed SRM before inserting the gastroscope due to transient respiratory depression ( P<0.01).Conclusion The application of intravenous small dose of ketamine combined with continuous infusion of propofol and sufentanyl in painless gastroscopy is effective and safe.

Changes of Circuratory Response during Intubation by Small Dose Fentanyl / 대한마취과학회지

Induction of general anesthesia with tracheal intubation is routine procedure but causes significant tarchycardia and hypertension. Many approaches have been tried to attenuate these circulatory response. The effects of small dose fentanyl on arterial pressure and heart rate increase during intubation were studied in 40 normotensive patients, who were randomly allocated to two groups, receiving saline (Control group) or fentanyl 2ug/kg (Fentanyl group), in a double blind fashion during anesthetic induction with thiopental 5mg/kg. Systolic, diastolic, mean arterial pressure and heart rate were measured and rate pressure product was calculated. All parameters were significantly different between two groups (p<0,05) and control group was significant increase in blood pressure and heart rate compared with pre-induction value but fentanyl group was relatively small changes of blood pressure and heart rate (p<0.01). After tracheal intubation, incresed blood pressure was returned to pre-induction value within two to three minutes in fentanyl group but heart rate was not returned pre-induction value within 5 minutes. Dose of fentanyl that are low enough to cause any side effects of drug itself, no notable side effects were observed during study and recovery.